Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia

• Published in: Haematologica (Roma) Vol. 102; no. 7; pp. 1291 - 1298
• Main Authors: Kekre, Natasha, Zhang, Ying, Zhang, Mei-Jie, Carreras, Jeanette, Ahmed, Parvez, Anderlini, Paolo, Atta, Elias Hallack, Ayas, Mouhab, Boelens, Jaap Jan, Bonfim, Carmem, Deeg, H. Joachim, Kapoor, Neena, Lee, Jong-Wook, Nakamura, Ryotaro, Pulsipher, Michael A., Eapen, Mary, Antin, Joseph H.
• Format: Journal Article
• Language: English
• Published: Italy Ferrata Storti Foundation 01.07.2017
• Subjects: Adolescent; Adult; Anemia, Aplastic - diagnosis; Anemia, Aplastic - mortality; Anemia, Aplastic - therapy; Antilymphocyte Serum - therapeutic use; Bone Marrow Transplantation - adverse effects; Bone Marrow Transplantation - methods; Comorbidity; Female; Graft vs Host Disease - etiology; Histocompatibility Testing; Humans; Infection - etiology; Male; Middle Aged; Risk Factors; Severity of Illness Index; Siblings; Survival Analysis; Treatment Outcome; Unrelated Donors; Young Adult
• ISSN: 0390-6078; 1592-8721; 1592-8721
• DOI: 10.3324/haematol.2017.164459

For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% 6%, <0.001) and chronic (20% 9%, <0.001) graft- -host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, =0.76, respectively. Among recipients of unrelated donor transplants, acute graft- -host disease was also higher with horse compared to rabbit antithymocyte globulin (42% 23%, <0.001) but not chronic graft- -host disease (38% 32%, =0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% 83%, =0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.